I have done a bit of research into ways of having a good death when Death already stands over your shoulder. First I want to make clear what I am not speaking about.
- Physician-assisted suicide. This is a nasty can of worms and invites abuse by people who already wreak a fair amount of harm on their patients. Overriding their oath, already known often in the breach, to “do no harm,” seems like a particularly bad idea. I DO NOT support any such legislation, or any such action. It has turned into the slippery slope that had been predicted when Kevorkian went on a media rampage, with a depressed teenager in Holland recently put to death like an unwanted dog. Horrible, unthinkable, criminal.
- I DO NOT support suicide. The suicide of unhappy, often depressed or PTSD-affected soldiers and others, is an awful thing to do to self, which CAN heal, to those who love the person, and the whole world which has lost the potential love and other gifts this person may have conferred. I support a society that views suicide as a wrong against the universe-given self, and a tragedy all around. Life is an improbable gift; a good society recognizes it and does everything to help people treasure it.
- There are some people (viz below) who speak of “self-deliverance” which sort of mixes everything together, including lethal injections by doctors. Weirdly enough, when you search online for self-deliverance, most links that come up are about deliverance from demons. As well they might, the way pro-euthanasia groups have behaved, and the kind of legislation they have at times pushed for.
I speak of a self-chosen departure when natural departure is imminent, and continued existence is virtually certain to entail profound suffering. Some people may indeed choose the natural way, even if it means hospitals and ICUs. But generally, we do not wish it on other people; we recoil in horror, reading of or observing the suffering natural death often enough entails. We do not wish it on animals either, whether a beloved pet, or a wounded deer on the side of the road. There is no spiritual benefit by choosing more suffering over less.
In my foray into dying proper, I have obtained a rather well-known book Final Exit (third revised edition) by Derek Humphry. It is a disappointment, and I do not recommend it. It does have some useful things to say, and I will quickly summarize them. His advice is to discuss your wishes with your loved ones, to write them down, best in a document called Advanced Directive (Living Will and Power of Attorney for Health Care), that letters be written to loved ones, and to study carefully the options before you well before you need them. So far so good.
I want to add that I do not see a legal prescription of drugs that can (if so chosen) be used to hasten one’s departure, as doctor-assisted suicide. The doctor need not know. When I was dying of cancer, opiates were prescribed to me freely, and that is how it should be. Only the drug war stands in the way of people having access to the drugs they need, for whatever reason. I am opposed to treating adults like children who cannot be trusted to make their own decisions. Oh, on alcohol and tobacco, the biggest killers, free access to adults, and in the time of covid, an essential business! But opiates for people in pain? Let’s crack down! Let them buy it off the street and perish! Sigh. Another story.
So back to Final Exit. The foreword, and actually, most of the book is shameless propaganda for euthanasia, and I will not use that word again, except as in veterinary practice.
When it comes to self-hastened death, there are various options. Humphry dwells a lot on techniques that are fast and certain, in his opinion, as though prolonged sleep from which a person may wake is anathema. He discusses many suboptimal options, like cyanide poisoning and self-injecting oneself with a large amount of air. Not a good way to die, apparently, though fast. He also spends a whole chapter on more bizarre ways to die, via ovens, intentional freezing to death, household cleaners, large doses of aspirin, and poisonous plants. There is a chapter on death by starvation. Another on carbon monoxide poisoning in a car. A detailed and creepy chapter on putting a plastic bag over one’s head and taking some sleeping pills. Ugh. There is a thoughtful chapter on “when” and a strange chapter on dying along with your partner. Another one has a checklist of all to do just before.
Well, the “good” options are as follows:
- Drug overdose (he favors barbiturates, particularly Nembutal, not opiates, and briefly mentions a few others, less suitable)
- Inert gases (e.g. helium)
And that’s it. The reason he does not like opiates is that the killing dose for one person may not kill another, they’d wake up, and could end up in a psychiatric ward. Or the last sleep may last many hours (apparently that is counted as an inconvenience in his world). As I had mentioned, he seems rather obsessed about doing it quickly. To my mind, doing it slowly makes more sense, as long as I make sure I don’t end up in the psychiatric ward.
Apparently, his more recent book, only available online as an ebook, goes into greater detail on how to kill yourself with helium. Yes, a plastic bag over your head is part of it, you should practice beforehand, and it takes about 30 minutes to die. And if you should be found and rescued, expect brain damage and paralysis. I think I’ll pass.
My own take: barbiturates are quite difficult to obtain (even in Mexico, he notes), as they have been replaced by benzodiazepines as the prescription drugs for sleep and anxiety. He never comments on what one feels with barbiturate overdose, only that the taste is horrible and best washed down by a stiff drink. In fact, the pills are so nasty that antiemetics should be taken prior. Yay. Oh and if you should perchance wake from an uncertain dose, you may be kidney-damaged. Or you may stay awake and take days to die. I am sitting here scratching my head. Compared to a slow dreamy passing via an approximate dose of poppy derivatives? They are relatively easy to obtain, store well for a long time, taste fine, you’ll enjoy the feeling as you drift away, and if you should wake after all, all you need to worry about is constipation. End of story.
Leaving Babylon 
August 29, 2020 at 2:33 am
You’ve made your position clear.
I had a friend. She contracted amyotrophic lateral sclerosis (ALS) and suffered it slowly for years. She was a musician. After a time, she was no longer able to indulge in the thing that gave her most pleasure. She was fiercely independent-minded, and deeply hated that she had to rely on others to help her do even the most basic and most personal things. Eventually, she felt forced to take her own life — by suffocating herself in a plastic bag — before she became totally dependent on her loved ones for absolutely everything. Her husband was originally accused of having assisted in her suicide, though, fortunately, this was not pursued in his case.
My position is that I feel that there are some situations in which those who take the oath to ‘do no harm’ ought really take a step back and consider what ‘harm’ actually means.
PS pedantic point but: it’s not ‘Advanced Directive’. It’s ‘Advance Directive’. So called because it’s a directive one makes in advance. There is no ‘Basic Directive’. It’s a very common mistake: I’ve even known clinicians to make it (they don’t know everything).
August 29, 2020 at 10:22 am
Yeah. It turns out this Derek Humphry did kill his first wife with barbiturates. She too had a severe progressive disease, and they had previously agreed on this. He mixed the stuff for her to drink. He says she died peacefully in 50 minutes, but given his enthusiasm for plastic bags, I have a feeling it may have played a role. He did eventually tell publicly what happened, but the authorities chose not to pursue it.
As for doctors killing people, NO. I will never agree to institutional killing. Too many mines buried in this particular path.
You are right. And I think the error is mine. Advance Directive. And the Power of Attorney he recommends applies only to health care decisions, and the person in charge cannot be an heir.
August 29, 2020 at 5:44 pm
You know, Wibbler, you bring up the other part of this. I did not want to make a long post, and so what I said applies to someone who is still able to make their own decisions and carry them out. But what of the other possibility?
I agree there ought to be a way. Here are my “rules.”
1. The “assistor” must know and care for (i.e. love, and have the best interests in mind for) the person departing. This knocks out institutional personnel, including physicians and nurses.
2. The person departing must agree, if they still have that power. This knocks out the case in Holland where an older woman with Alzheimers was slated to be put down. She had enough wits about her to know what was happening, and fought back. Her family was asked to hold her down so the doctor could administer the lethal injection. Jayzus feck.
3. I invite folks to add more guardrails. I may think of others. But these are my core non-negotiables.
August 30, 2020 at 2:38 am
I’m glad to hear that you’re not averse to the idea of assisted dying in the case unbearable suffering. (‘More palliative care’ is what many say is needed, but in some cases this cannot help, as in the case I read about recently where the person died while vomiting shit — yes, through their mouth — because of an intestinal blockage).
Concerning your core non-negotiables:
1. Clinical folk can administer lethal injections. Anyone else would likely fuck it up.
2. Yes, of course they must agree, if capable. You don’t address the case where they’re incapable: that is a thorny one. Concerning your Holland case: that is, indeed, appalling.
3. There are organisations that are working on ‘more guardrails’. I’m a member of one such: Dignity in Dying,
August 30, 2020 at 9:35 am
No lethal injections, please. Leave that to the veterinarians.
Opiates work just fine, and don’t need specialized personnel. What’s the rush? Do we need a conveyor belt?
For incapable folks, if they have Power of Attorney for Health Care, that’s one way. If they don’t (and most people don’t), then a non-heir could be assigned by the family, say a good friend of the person in question.
Will look up your link.
Edit: So I did. Why do they call it assisted dying when their guidelines are:
* limited to terminally ill and mentally competent adults
* requires the dying person to end their own life and does not permit another person to do it for them
This group cuts out medical personnel. Why don’t you?
August 30, 2020 at 12:32 pm
Opiates? Where can I get opiates? Please tell me….
August 30, 2020 at 3:58 pm
I don’t know about Britain. You can ask around.
Here in the States, it depends on where you live. In Oregon, you can ask a doctor for a prescription. Here in Colorado, there exists a list of clinics willing to prescribe what you need; often they are cancer clinics, but not all.
My doc is willing to prescribe opiates once I get off benzos for pain, in smallish amounts, and if I stock up, I am set later on. They keep very well. And then, there is poppy seed tea. DIY.